Panda Naresh K, Saravanan Karuppiah, Chakrabarti Arunaloke
Department of Otolaryngology and Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Am J Otolaryngol. 2008 Jan-Feb;29(1):24-30. doi: 10.1016/j.amjoto.2006.12.004.
The increasing volume of literature on Aspergillus sinus infection is confusing because different authors stress different aspects of the disease. It is generally accepted that standard therapy consists of surgical debridement and medication with systemic amphotericin B. Patients who fail the standard therapy or those who cannot tolerate amphotericin B pose a dilemma. This study attempted to address the issues concerning combination therapy in invasive aspergillosis.
We conducted a prospective randomized study on 6 apparently immunocompetent patients with invasive aspergillosis complicated by orbital and intracranial spread. All the patients were treated with a combination of amphotericin B (2.5 g) and itraconazole (6 months). They were monitored clinically and radiologically before, during, and after their combined antifungal therapy management.
Among the 6 immunocompetent patients, orbital involvement was seen in 5, skull base erosion with intracranial extension was seen in 2, and infratemporal fossa extension was seen in 2. After completion of treatment with 1.5 g of amphotericin, the paranasal sinus part of the lesion disappeared. However, there was residual lesion in the intracranial part that completely disappeared only after treatment with 2.5 g of amphotericin and 6 months of itraconazole therapy.
Invasive aspergillosis has been increasingly reported among immunocompetent patients. No single surgical or medical maneuver, including orbital exenteration, guarantees cure. The combination of amphotericin B and itraconazole for skull base aspergillosis represents a real step forward in the treatment of invasive aspergillosis.
关于曲霉性鼻窦感染的文献数量不断增加，这令人困惑，因为不同作者强调该疾病的不同方面。一般认为标准治疗包括手术清创和全身使用两性霉素B药物治疗。标准治疗失败的患者或不能耐受两性霉素B的患者面临两难境地。本研究试图解决侵袭性曲霉病联合治疗的相关问题。
我们对6例表面免疫功能正常但患有侵袭性曲霉病并伴有眼眶和颅内播散的患者进行了一项前瞻性随机研究。所有患者均接受两性霉素B（2.5克）和伊曲康唑（6个月）联合治疗。在联合抗真菌治疗前、治疗期间和治疗后，对他们进行临床和影像学监测。
在这6例免疫功能正常的患者中，5例出现眼眶受累，2例出现颅底侵蚀并伴有颅内扩展，2例出现颞下窝扩展。在使用1.5克两性霉素治疗完成后，病变的鼻窦部分消失。然而，颅内部分仍有残留病变，仅在使用2.5克两性霉素和6个月伊曲康唑治疗后才完全消失。
免疫功能正常的患者中侵袭性曲霉病的报道越来越多。包括眼眶内容剜除术在内的任何单一手术或药物治疗手段都不能保证治愈。两性霉素B和伊曲康唑联合治疗颅底曲霉病是侵袭性曲霉病治疗的一大进步。
